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HomeMy WebLinkAboutCLE200900150 Legacy Document 2012-10-01Application for Zoning Clearance I&— CLE# Z0Qq - /Sb Zoning Clearance = $35 OFFICE USE ONLY j Check # Date: 70-3 L/ PLEASE REVIEW ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION I �j G n Tax Map and Parcel: U 61 ma `00 °' I 0o' Existing Zoning I 6 Parcel Owner: P1 s1 Welter - _j 1 Parcel Address: 10C)o S/ 0PP9�5 tN(�dztpcity / °u'' /b �Ui� /GQ� State VA ' Zip ) -3— (include suite or floor) PRIMARY CONTACT �u �LI Who should we call /write concerning this project? L4 Address: 10()o 6140 J-fkf W OZ L DC� City LAa ',101/�V"1k State y� Zip Office Phone: � I +3 �'3 Cell # '1 ' 536 1 /I+ax # E -mail CG !'a(/fo � ��c�� r0 A APPLICANT INFO TION Check any that apply. Change of wnershi}p, Change of use Change of nam New business /e Business Name /Type: �� � 1 llG /P� �" Sfd � C ,b,'nz. ) Previous Business on this site Describe the proposed business including use, number of employees, number of shi ts, available parking spaces, number of �� Cf% vehicles, and any additional information that you can provide: .S�'4 a� $��� r oaf *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. �my Signature A � I I/1 C W�i( Printed Y t.g T1 V11 w L4 AP ROVAL INFORMATION PApproved [ V as proposed [ ] Approved with conditions [ ] Denied [ ] Bacicflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site c mplies ith the site plan so phis date. Notes• / aiu Building Official is Date '--t rI ('3 Zoning Official Date ©`( Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 04/28/08 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well or public water? If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health_ Dept. FAX DATE Circle the one that applies Is parcel on septic or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # - Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # 7nnina to emminlata 1-hp fnllnwina. Reviewer to complete the following: Square footage of Use: X371 Y/N ermitted as:,�,/5�5eoj-co Under Section: Supplementary regulations 1eccttion: Ct Parking formula: AO Required spaces: h [(1 Y/N N Items to be verified in the field: Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: Y/N If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 04/28/08 Page 3 of 3